Human Immunodeficiency Virus Infection Is Associated With Increased Meningococcal Carriage Acquisition Among First-year Students in 2 South African Universities

Susan Meiring; Cheryl Cohen; Linda de Gouveia; Mignon du Plessis; Karistha Ganesh; Jackie Kleynhans; Vanessa Quan; Stefano Tempia; Anne von Gottberg

doi:10.1093/cid/ciaa521

Human Immunodeficiency Virus Infection Is Associated With Increased Meningococcal Carriage Acquisition Among First-year Students in 2 South African Universities

Clin Infect Dis. 2021 Jul 1;73(1):e28-e38. doi: 10.1093/cid/ciaa521.

Authors

Susan Meiring^{1

2}, Cheryl Cohen^{2

3}, Linda de Gouveia³, Mignon du Plessis^{3

4}, Karistha Ganesh³, Jackie Kleynhans³, Vanessa Quan¹, Stefano Tempia², Anne von Gottberg^{3

4}

Affiliations

¹ Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa.
² School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
³ Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa.
⁴ School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Background: Invasive meningococcal disease clusters occur among university students and may reflect higher carriage prevalence among this population. We aimed to measure meningococcal carriage prevalence, acquisition, and risk factors among first-year university students in South Africa.

Methods: In summer-autumn 2017, after consenting to participate, we collected oropharyngeal swabs and questionnaires on carriage risk factors and tested students for HIV at 2 universities, during registration week (survey 1) and 6-8 weeks later (survey 2). Meningococci were detected by culture and polymerase chain reaction.

Results: We enrolled 2120 students at registration. Mean age was 18.5 years, 59% (1252/2120) were female and 0.8% (16/1984) had HIV. Seventy-eight percent of students returned for survey 2 (1655/2120). Among the cohort, carriage prevalence was 4.7% (77/1655) at registration, increasing to 7.9% (130/1655) at survey 2: 5.0% (83) acquired new carriage, 2.8% (47) had persistent carriage, 1.8% (30) cleared the initial carriage, and 90.3% (1495) remained carriage free. At both surveys, nongenogroupable meningococci predominated, followed by genogroups Y, B, W, and C. On multinomial analysis, risk factors for carriage acquisition included attending nightclubs (adjusted relative risk ratio [aRRR], 2.1; 95% CI, 1.1-4.0), having intimate kissing partners (aRRR, 1.8; 95% CI, 1.1-2.9) and HIV (aRRR, 5.0; 95% CI, 1.1-24.4).

Conclusions: Meningococcal carriage among first-year university students increased after 2 months. Sociobehavioral risk factors were associated with increased carriage for all analyses. HIV was associated with carriage acquisition. Until vaccination programs become mandatory in South African universities, data suggest that students with HIV could benefit most from meningococcal vaccination.

Keywords: Neisseria meningitidis; Southern Africa; carriage; meningococcus; risk factors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Carrier State / epidemiology
Cross-Sectional Studies
Female
HIV Infections* / epidemiology
Humans
Meningococcal Infections* / epidemiology
Neisseria meningitidis* / genetics
Prevalence
South Africa / epidemiology
Students
Universities